Gastrointestinal procedures that generate high levels of smoke pose significant health risks to operating room personnel.
This is according to a recent study that suggests endoscopic smoke has the toxic equivalent of one cigarette per procedure over the course of a career.
Trent Walradt, a research fellow at Brigham and Women’s Hospital and lead author of the study, explained: ‘Surgeons in the operating room have regulations and guidelines to mitigate smoke exposure, but that does not exist for gastrointestinal endoscopy. When you’re using cautery, it generates a smoke plume. We wanted to know whether the smoke produced during some of our endoscopic procedures is dangerous.’
The results were presented at Digestive Disease Week (DDW) 2024 in Washington, US.
Staff at risk included those attending certain smoke-producing endoscopic gastrointestinal procedures, including a procedure that uses electrical current to remove polyps.
Researchers placed equipment in an endoscopy lab during 27 procedures at Brigham and Women’s Hospital to evaluate air quality before and during four different types of gastrointestinal endoscopic procedures that produce smoke.
These included procedures to stop bleeding, reduce the size of the opening to the small intestine after gastric bypass, or remove cancerous and pre-cancerous polyps near the muscle.
The study found that volatile organic compounds peaked at twice the EPA’s maximum safe level.
Ultrafine and fine inhalable particles were consistently elevated, with the highest averages during argon plasma coagulation.
This procedure uses argon gas and an electrical current to cauterise and remove tissue. The intensity and length of exposure during a single procedure were similar to smoking a cigarette.
Chris Thompson, director of endoscopy at Brigham and Women’s Hospital and principal investigator, said: ‘Over the course of a career, endoscopic smoke may pose significant health risks to personnel in the endoscopy suite. If you're doing four or five procedures a day, that’s five cigarettes a day. Over the course of a week, it’s like you're smoking a pack of cigarettes. That's not acceptable.’
He added: ‘We’re in the early phases of this, but I think our findings are very important and, quite frankly, a little concerning and surprising.’
Procedures included in the study were argon plasma coagulation, gastric endoscopic submucosal dissection, colonic endoscopic submucosal dissection and ampullary sphincterotomy.
Additional research is needed to better understand the threat, but researchers say possible solutions include using insufflators, devices that deliver gas to open up space within the body during surgery, or other devices to remove smoke during procedures, using masks, or making changes to how procedures are performed to produce less smoke.
